Disability predicts maturation failure of hemodialysis arteriovenous fistulas.
Journal
Vascular medicine (London, England)
Journal Volume
30
Journal Issue
6
Start Page
696
End Page
702
ISSN
1477-0377
Date Issued
2025-12
Author(s)
Abstract
Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to fewer complications, yet many fail to mature. Although clinical predictors have been studied, results remain inconsistent. Recent guidelines recommend considering functional status when selecting access, but evidence is limited. This study evaluated the impact of functional status on fistula maturation.
In this retrospective cohort study, we included 315 patients who underwent AVF creation at a university hospital. Data were collected on demographics, comorbidities, and AVF characteristics. Functional status was measured by the Katz Activities of Daily Living (ADL) Index. The primary outcome was overall clinical AVF maturation within 270 days. Secondary outcomes included unassisted maturation and AVF abandonment.
Of the 315 patients analyzed, the mean age was 66 years (SD, 13 years) and 43% were women. Clinical AVF maturation rates at 3, 6, and 9 months were 34%, 60%, and 72%, respectively. Patients with severe disability (Katz ADL score 0-2) had lower maturation rates (23%, 43%, and 47% at 3, 6, and 9 months) compared to those with partial or no disability. In univariable analysis, clinical maturation of AVF at 9 months was associated with age, female sex, unmarried status, cardiovascular disease, larger arterial diameter, and severe disability. In multivariable analysis, severe disability was independently associated with maturation failure (OR 2.439, 95% CI 1.028-5.784, = 0.043).
Disability, measured by the Katz ADL Index, independently predicts lower AVF maturation rates. Patients with severe disability may require tailored interventions and closer monitoring.
Subjects
arteriovenous fistula
chronic kidney disease
dialysis access
disability
hemodialysis
maturation
SDGs
Type
text::journal::journal article